Each of the 50 states and the District of Columbia has adopted its own statutes governing advance directives that allow people to communicate their end-of-life wishes. Intended to safeguard patients’ rights, these laws may unintentionally prevent some patients—Latino, Native American, Asian, homeless, institutionalized, isolated elderly, disabled and non-English speaking—from making their preferences known or having them honored.
When researchers examined state statutes they found five areas that present barriers:
- Poor Readability—most statutes are written above the 12th-grade reading level, even though 40 percent of the population reads at or below the 8th-grade level.
- Health Care Agent—many states restrict who may serve as a health care agent, intending to protect patients from having practitioners or caseworkers serve as such but often not recognizing same-sex or domestic partners.
- Execution Requirement—witnesses or notaries often are needed to make advance directives legally binding.
- Inadequate Reciprocity—while most states honor advance directives from other states, they do not necessarily interpret the documents similarly.
- Religious, Cultural and Social Inadequacies—preferences outside a Western cultural bias are not permitted.
The researchers make recommendations for modifying advance directive laws to improve their clinical effectiveness and to shift the focus from a legal-transactional approach to a communications-based one.